The medical science book chapter chooses a plait:Oesophagus disease

Section 1 oesophagus cancer and Ben door cancer

A, Epidemiology

The oesophagus cancer is mankind one of more familiar malignant tumors, it seriously threatens the people's life and health, according to annually there are about 20 myriad peoples in estimate whole world die in an oesophagus cancer.

The outbreak rate of oesophagus cancer has an obvious geography characteristics, even close together two sides area, its outbreak rate has obvious difference.See from the whole world scope, Gao Fa classifies cloth in Iran, South Africa, get the west be second and China, but Israel in Europe, America, Oceania, Asia the average outbreak rate be very low, mostly at 5/100,000 following.Have various malignant tumor to firstly have 9 provinces at the our country oesophagus cancer, north China three provinces such as provinces, Sichuan province and Guangdong etc. all have obviously high one in surroundings the high hair center of the region, such as north China oesophagus cancer of main the concentration is going the mountain south segment to hand over boundary region too much, its outbreak rate over 130/100,000.It is the main reason of that male and female death in the region.But be apart from to go the mountain not far other counties too much, the death rate of the oesophagus cancer declines to 2/100,000 following.Guangdong outbreak's ising the tallest is Nan-ao island.The Sichuan is mainly concentrated in the salt station, Lang of the northwest of the Chuan and three counties in the south hand over boundary region.In addition, the provinces such as Shandong, Jiangsu, Fukien, Anhui, Hubei, Xia west and Xinjiang etc. also have an oesophagus cancer Gao Fa Qu of the opposite concentration and have already found out the average year death rate of oesophagus cancer in more than 20 county City over 100/100,000.

Two, pathology, cent type

(A)histology characteristic:The oesophagus cancer occurrence glues the film epithelial base cell at the oesophagus, the great majority is the scale form top skin cancer(95%), the gland cancer originates an oesophagus even seldom seen, Be located on oesophagus bitter end more.The Ben door cancer is much a gland cancer, can also extend to invade oesophagus.

(Two)clinical pathologic cent type

1.In early days big body pathologic cent type:

(1)lie low a type:The oesophagus glues a film to only have a light degree Chong blood or glue a film rough, naked eye's doesing not easily recognize and can use to shed off cytology and organization to cut into slices is a diagnosis basis, all is cancer for oesophagus for the home position cancer of expect at the earliest stage.

(2)debauched type:Glue the film surface is very shallow debauched, the shape size is different, boundary boundary clear, the form is like map.The cancer organization divide worse, home position cancer and invade in early days each smooth have a half, compare the first night of development.

(3)spot piece type:The surface glues a film to slightly swell up, uneven, the wrinkly plait disappear, year skin tinea kind, pathological changes scope the size be different, than ex- type develop of more late and about the home position cancer have 1/3, invaded a smooth cancer to have in early days 2/3.

(4)nipple type:The obviously hard knot of the tumor formation, have of like nipple, have of the elephant take the polyp form of short Di, to chamber inside outstanding, the cancer cell divide better, the great majority was in early days to invade a smooth cancer, is earlier period cancer most late of type.

2.Medium later period big body pathologic cent type:According to the X line check and pathologic and big body see, is divided into an oesophagus cancer several category type as follows.

(1)marrow type:The most familiar, have 60% around, the tumor often involves in the oesophagus whole layer, and surround a tube chamber long toward the chamber ectendomycorrhiza, formation more and greatly but irregular tube form lump.

(2)mushroom umbrella type:Have 15% around, tumor to glue a film surface growth, become a flat even lump, involve in oesophagus a part of the path for week, have another to tube outstanding inside chamber such as mushroom mushroom form, boundary clear.

(3)ulcer type:Have 15% around, the hollow ulcer of the tumor formation, erode parts of oesophagus walls, generally don't produce a tube chamber to seriously stop.

(4)the Suo narrow type:Have 10% around, cancer swollen formation wreath form or short tube the form be narrow, narrow above the oesophagus extend.

(5)type inside the chamber:More seldom seen, have 3% around, the cancer is swollen to present polyp kind outstanding there are Di and oesophagus wall connect with each other inside chamber toward the oesophagus tube, the surface is debauched, ulcerate and can invade a muscle layer.

3.Ben door big body pathologic cent type of the cancer:Its diagnosis and treatment all had with oesophagus cancer many common place when Ben door belonged to gastric structure on the dissection, but malignant tumor happenned, past Ben door the cancer also brought into an oesophagus cancer description.Ben door the big body pathologic cent type of the cancer is is divided into as follows a few kinds:

(1)the type of condy-loma accuminata:The tumor mainly becomes the lump of the elephant"condy-loma accuminata" kind to growth inside the tube chamber.

(2)fill the air to invade a smooth type:The tumor invades smooth scope more wide, can involve in the big department of oesophagus and stomach, the stomach wall has already increase thick, glue a film is debauched.

(3)ulcer type:The tumor is a big ulcer and often wear to go into a close by dirty machine.

(4)mixture type:Have another is a later period pathological changes and have already can't press the above cent type.

Three, earlier period and later period express

(A)express in early days:The ① swallowed food Geng to choke feeling, often cause because of taking a meal solid food, for the first time after appearing Geng to choke feeling, not through treatment but disappear by oneself, again appear every few days or few months.Ache after the ② breastbone, often take place after swallowing food, take a meal rough hot food or stimulating food aggravate.The ③ food pass slow-moving also be detained feeling.④ Sword the bottom of the Tu burns bright kind piercing, importance not etc., have another to appear while swallowing food, food after ease or disappear.The ⑤ swallows a department dry with tighten feeling, food swallow not Chang, also slight ache.The empress of the ⑥ breastbone the stuffy bulge be unwell.

(Two)medium, later period symptom

1.Swallow a difficulty:Carry on sex's swallowing a difficulty is an oesophagus the main symptom of the cancer.The beginning took a meal solid food to have Geng to choke feeling when beginning rise, hereafter present to carry on sex to aggravate gradually, even the liquid substance food can't swallow, either bottom.Swallow difficult serious degree in addition to having something to do with get sick expect, with the type of tumor as well relevant fasten.The Suo narrow type appears the symptom of Geng Zu early but the severity, ulcer type and type inside the chamber appear the symptom of Geng Zu to compare with night, .

2.Ache with vomit:See in seriously swallow a difficult case, presented the food in company with saliva Ou which just took a meal more to glue a liquid form.The ache also is a familiar symptom, after being located on breastbone more, shoulder area, presented by fits and starts more in early days, appeared to keep on but serious chest pain or backache, needed to relieve pain with the analgesic, outside invaded for the tumor in later period of advertise for elephant.

3.The Ben door cancer sufferer can appear then blood, anemic.

4.The weight descend and the quality of bad disease:Because swallow a difficulty over a long period of time, cause nourishment obstacle, the weight obviously descends, emaciated obvious.Appear the bad liquid quality is a performance of tumor later period.

5.The symptom that the close by organ implicate:The tumor invade and the close by organ can cause homologous symptom.

(Three)the body advertise for

The sufferer had no obvious body to advertise for in early days.The later period case can have a lymphoid the top of the lock bone knot swollen big, emaciated and bad liquid quality, later period Ben door the cancer sufferer much has to press pain or pack piece up the belly.

Four, diagnose

(A)the history of disease

(Two)the X line oesophagus barium the meal build a shadow:BE a later period oesophagus the main method of the cancer is in the diagnosis.It is thus clear that the oesophagus glues a film line to break off, mess, the tube chamber different degree of narrow, the defection and damage of Chong Ying, niche shadow, tube the wall extend to be subjected to a limit, stiff and rigid etc..The pathological changes canned have no male detection in early days.

(Three)the oesophagus pull net cytology a check:The oesophagus pull net cytology the masculine gender rate of the check is 90%, this kind of method operation simple, pain and sufferings little, in the anti-cancer the census is useful.

(Four)fiber oesophagus the mirror check:This is to diagnose the oesophagus cancer more dependable method, but is located on to glue a film layer because of the earlier period oesophagus cancer smaller, inside peep a mirror to easily leave out, if check infuse into AN aniline in the oesophagus chamber blue or iodine aqua the dyeing then contributes to earlier period cancer of detection.Can do to glue a liquid Tu2 Pian4 inside chamber in the meantime when fiber oesophagus mirror check with take to live body organization a check.

Five, discriminate diagnosis

(A)oesophagus benign tumor

(Two)the Ben door convulse

(Three)the oesophagus scar formation be narrow

Six, the surgery cure

The surgical operation is an oesophagus cancer the head of the treatment choose a project.Any one who match following condition, take aggressive surgical operation treatment as proper.

1.Adaption:

(1)patient's whole body be in good shape, heart, brain, lung, liver, kidney each main and dirty machine function be basic and normal and estimate ability to be subjected to a surgical operation.

(2)have no distance to transfer.

(3)the partial pathological changes can cut off.

2.Surgical operation method

(1)oesophagus cancer:Parts of oesophagus resections, the oesophagus stomach fits together Shu or uses the bowel tube reconstruction oesophagus.

(2)Ben door cancer:The parts of stomaches, oesophagus cut off and the oesophagus stomach fits together Shu.

3.Don't cure for good sex surgical operation:Can make to place tube Shu inside chamber for can't surgical operation cut off of case, the oesophagus stomach bottom fits together Shu, or the stomach build Lou Shu.